[Sulbenicillin and amikacin for febrile patients with cancer--with special reference to granulocytopenia].

Between March 1978 and March 1983 ninety-four episodes of fever in 56 mainly granulocytopenic patients with cancer were treated empirically with a combination of sulbenicillin (5.0 g, every 6 hours) and amikacin (200 mg, every 6 hours) in Saitama Cancer Center. Profound granulocytopenia at the beginning of treatment (less than 100/mm3 of granulocytes) was present in 66% of the patients. Oral absorbable or nonabsorbable antibiotics were used in 59 febrile episodes. WBC transfusion was not given. The response rate for all documented infections was 75%, including 10 of 13 (77%) of bacteremias. The majority of infections with identified organisms were caused by aerobic gram-negative bacilli: the major gram-negative pathogens being Ps. aeruginosa (11 cases), Klebsiella spp. (7 cases), E. coli (7 cases) and Enterobacter spp. (7 cases). The response rate of gram-negative bacilliary infections was 74%. Pneumonia responded less satisfactorily than all other types of infection with the response rate of 20%. The response rate of 69% for profound persistent granulocytopenia (less than 100/mm3 of granulocytes without a rise during therapy) is higher than that of any other reports. The most common adverse effect was hepatotoxicity (19%), whereas oliguria or anuria occurred in two patients, by which they eventually expired.